Email 305: ARV's and Vomitting

Posted by Pozziepinoy on 7:44 AM

I got diagnosed of HIV last 23Jan'13. Started ARVs (Lami+Zidu and Nevi) last 01Feb'13 as per my doctor's advise even though I didn't undergo lab tests yet. My doctor's reason is that to avoid other complications especially the opportunistic infections as early as now before it's too late. The only tests I've done are the CD4 and HIV RNA. Until now i still don't know the results since they are forwarded immediately to my doctor's clinic in "Hospital A". I can't claim it on my own since I'm using an alias. I always visited my doctor's clinic in "Hospital B". 

The first 2 weeks of taking the ARVs was ok. I didn't have any side effects like the rashes. Then 1 day I had chills then experienced stomach aches. Then the next day I had experienced a hard in breathing. I immediately called my doctor and she advised me to stop the medication for the meantime. I stopped for a week, where I experienced some headaches, then resumed my ARVs.

When i resumed in taking my ARVs dito na nagsimula problema ko. Everytime i take the tablets nag-iiba ang feeling ng stomach ko. Feeling ko na nasusuka ako always. Nakakawala din ng gana kumain dahil parang yung tyan ko ayaw tanggapin kahit anong pagkain or tubig man lang. I then went to my doctor and she prescribed me a med called: Omeprazole. Taken once everyday 30min before breakfast. It did help a little but ganun pa rin. Nasusuka ako. Sabi ng doctor mawawala din yan at masasanay din yung body ko nito. But the next few days hindi ko na talaga sya matiis. Nagstop ako magtake ng ARVs for 3 days at bumalik ang sigla ko at ganang kumain. Hindi na rin ako naka-experience ng upset stomach. Then I resumed again. Bumalik na naman ang feeling na nasusuka ako. Dahil dun i stopped for another week.

When i visited again my doctor for a refill of my ARVs, i told her about what happened. She was disappointed na pinutol-putol ko ang medications ko. Baka daw magka-develop ng resistance sa gamot ang body ko. I honestly didnt know about this and i realized i made a very huge mistake. After that i decided to really take the medicines. Pero ito na naman... nasusuka na naman ako. Just before writing this email to you, muntik na akong nasuka kahit na kalalagay ko lang ng tablet sa bibig ko.

I really dont know na what to do. I really want to take these meds pero hindi sya inaaccept ng tyan ko. Nakakaapekto pa sya sa appetite ko. Ayoko manghina dahil dito. Tried asking help sa twitter pero walang nakakapansin sa tweets ko. I felt like im alone dahil im not from manila. Mostly dun sa twitter na fina-follow ko na pozzies are from manila. I need some advise especially dun sa mga tao na parehong ARVs na tini-take ko if they experienced the same thing and how they overcome the side effects. I badly needed help on this. Pasensya na sa mga grammar ko dito kasi while doing this nagaa-upset na naman ang tyan ko at para na naman akong masusuka. 

Thank you so much for taking time on reading this.

XXX

TRANSLATION
I got diagnosed of HIV last 23 Jan'13. Started ARVs (Lami+Zidu and Nevi) last 01Feb'13 as per my doctor's advise even though I didn't undergo lab tests yet. My doctor's reason is that to avoid other complications especially the opportunistic infections as early as now before it's too late. The only tests I've done are the CD4 and HIV RNA. Until now i still don't know the results since they are forwarded immediately to my doctor's clinic in "Hospital A". I can't claim it on my own since I'm using an alias. I always visited my doctor's clinic in "Hospital B". 

The first 2 weeks of taking the ARVs was ok. I didn't have any side effects like the rashes. Then 1 day I had chills then experienced stomach aches. Then the next day I had experienced a hard in breathing. I immediately called my doctor and she advised me to stop the medication for the meantime. I stopped for a week, where I experienced some headaches, then resumed my ARVs.



When I resumed taking my ARV’s, that was when I problem started. Everytime I take the tablets, I feel something different in my stomach. I feel I want to always throw up. I also lose appetite because I feel that my stomach is rejecting any food or even water. I then went to my doctor and she prescribed me a med called: Omeprazole. Taken once everyday 30min before breakfast. It did help a little but I felt the same. I still feel nauseated. My doctor said it will go away and my body will adjust to it. But the last two days, I really couldn’t stand it. I stopped taking ARV’s for 3 days and I felt better and my appetite came back. I didn’t feel any upset stomach. Then I resumed again. The feeling of throwing up once again came back. Because of that I stopped for another 
When I visited my doctor again for a refill of my ARV’s, I told her what happened. She was disappointed that I kept on stopping taking my medications. She said that my body might develop resistance to the medicines that I am taking. I honestly didn’t know about this and I realized I made a huge mistake. After that I decided to really take the medicines. But once again, I feel like throwing up again. Just before writing this email to you, I almost threw up even though I just put the tablet in my mouth.

I really don’t know what to do. I really want to take these meds but my stomach is not accepting it. It is affecting my appetite too. I don’t want to get weak because of this. I tried asking help from twitter but nobody was paying attention to my tweets. I felt like I am alone because i am not from Manila. Mostly the people in twitter that I follow are from manila. I need some advise especially to those people who are taking the same ARV’s if they experienced the same thing and how they overcame the side effects. I badly needed help on this. Sorry for my grammar as while I am doing this I have an upset stomach and I feel like throwing up.

Thank you so much for taking time on reading this.

 XXX


POZZIEPINOY’S RESPONSE


Hi XXX.

Thank you for your email. Thank you for finding the blog.

There are some concerns that I want to address here and I want to do it in the order that I read from your email.

First, I am worried about you having an "alias" with your lab results especially the CD4 test as this may compound the problem later on. You know that everything is confidential here and the problem that I see here is that, like what you said, you can't claim it as your own and second it will have a problem later on with PhilHealth. Also, if you have a problem with your doctor or your hub, different "names" may pose a problem with their records. One more thing, you should have access to all your records so as you have something to hold on to during the process of your treatment. I for one, have all my documents, original and photocopies from the time I got diagnosed to my last recorded blood analysis.

Second, with your current doctor, I don't know why she didn't complete all your lab tests prior to your taking the ARV's and just asked you to take the CD4 and then proceeded with your ARV's. The hubs usually require PLHIV's to complete all labs for baseline, for something to compare with later on in case something will happen. In your case, your doctor won't even know what the effects of the ARV's are on your blood since you don't have baseline tests. I wonder why your doctor didn't even bother to get you tested for other infections. These questions need to be raised and only you can address them with her.

Third, with skipping the ARV's, it is a NO-NO to even think about stopping the ARV's. Your doctor has the right to be disappointed with you because you didn't follow her advice. Let me enlighten you with this.

1. Stopping taking the ARV's may really allow the virus to be resistant to the medicines that you are taking. This means that your virus might not respond well to the ARV's that you are taking during the course of your treatment.

2. The resistance to the ARV's will usually be seen in the viral load which is taken after a year of taking the ARV's. If this won't go down and the viral load still increases, the virus is resisting the treatment. In your case, since you don't have a viral load test, we will never know until you get your first viral load test.

3. The CD4 test might also go down which may also be a sign that the treatment is not helping you. However, CD4 has multiple factors affecting it, but if it goes does, you need to discuss it with your doctor.

Fourth, with your major complain of vomitting:

1. Your doctor is right in telling you to keep on taking it and let your body adjust to it.
2. You may need to continue the extra medicine that she prescribed you.
3.  However, if you feel that your body is getting weaker, you need to consult with your doctor again. I know somebody who had the same symptoms and his doctor monitored his CBC (complete blood count) and when his hemoglobin went down a little, the doctor switched to another ARV. That poses a problem in your case because you didn't mention if you had your CBC done, so there is nothing to compare with. 
4. You have to eat as frequent as possible especially after you threw up to nourish you body.
5. Also, report to your doctor when you experience throwing up. I am worried that you might also be throwing out the medicine that you are taking.
6. The ARV's are used to help us, but if you feel that your body can't handle it, tell your doctor ASAP. She might opt to switch again to another cocktail that will be best for you.

I know it is hard, but you have to keep on thinking positive about your treatment. Always believe that every time you'll be taking your ARV's, you won't throw up anymore as there might be a psychological factor here. You might as well, try, so your doctor will keep you on the first line of treatment.

I hope I was able to answer your concerns. Feel free to email me again if you have other questions.


Stay healthy,
Pozziepinoy





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